Member Navigator

Accountabilities: Member Support and Communication: Serve as the primary non-clinical contact for members through phone, email, and other communication channels, providing timely, professional, empathetic, and accurate assistance. Benefits and Program Education: Explain healthcare programs, eligibility requirements, benefits, available services, provider options, applicable processes, and next steps in clear, accessible language. Information Collection and Verification: Gather, verify, and document member demographics, eligibility details, benefits information, referrals, service requirements, and other relevant case information. Case Management and Resolution: Manage assigned member cases from initial intake through resolution, research questions, resolve routine issues independently, monitor progress, and coordinate follow-ups to ensure timely outcomes. Appointment and Service Coordination: Coordinate imaging appointments and other applicable healthcare services by identifying appropriate providers, facilitating scheduling, confirming appointment details, and communicating updates to members and providers. Cross-Functional Collaboration: Work with case management, clinical staff, clients, providers, and internal departments to coordinate services, support members requiring additional assistance, and facilitate appropriate clinical review when needed. Escalation and Barrier Resolution: Identify potential obstacles to care, service delays, sensitive issues, and non-standard requests, escalating clinical or complex matters to the appropriate teams in accordance with established procedures. Documentation and System Management: Maintain accurate, complete, and timely records of member interactions, scheduling activities, case progress, outcomes, and follow-up requirements in CRM, scheduling, case management, and other departmental systems. Provider and Partner Relationships: Build productive working relationships with healthcare facilities, providers, clients, and external partners to promote effective communication and timely service delivery. Administrative and Operational Support: Assist with claims-related activities, administrative tasks, and other operational processes associated with member cases as required. Quality and Performance: Meet established service-level agreements, productivity targets, quality standards, documentation requirements, and member satisfaction expectations. Program Flexibility and Cross-Training: Maintain up-to-date knowledge of supported programs, policies, systems, and business initiatives, and adapt to different workflows, queues, and responsibilities as operational needs change. Process Improvement: Collaborate with colleagues and cross-functional teams to identify opportunities to improve workflows, increase operational efficiency, and enhance the overall member experience. Compliance and Confidentiality: Follow established security procedures and applicable healthcare privacy requirements, including protecting sensitive member information in accordance with HIPAA and organizational policies. Requirements Education: High school diploma or GED required. Relevant Experience: At least 2 years of experience working in a remote call center environment. Healthcare or Customer Service Background: Experience in healthcare scheduling, patient or member access, healthcare operations, insurance, medical office administration, or another related customer support environment. Customer Service Excellence: Demonstrated ability to provide courteous, professional, accurate, and timely assistance while maintaining a positive member experience. Communication Skills: Excellent verbal and written communication skills, including the ability to explain complex information, healthcare processes, and administrative requirements in an understandable manner. Attention to Detail: Strong organizational skills and a high level of accuracy when collecting information, documenting cases, coordinating appointments, and managing follow-up activities. Problem-Solving: Ability to research questions, resolve routine issues, recognize situations requiring escalation, and follow established procedures to achieve appropriate outcomes. Time Management and Multitasking: Ability to manage multiple cases, meet deadlines, prioritize tasks, and maintain productivity in a fast-paced, service-oriented environment. Independent Work: Demonstrated ability to work independently, follow instructions and established workflows, exercise sound judgment within the role's scope, and complete assignments reliably. Technology Proficiency: Working knowledge of Microsoft Office applications, including Excel and PowerPoint, and the ability to navigate multiple computer systems and learn new platforms. Remote Work Readiness: Must be based in the United States and able to maintain a quiet, distraction-free workspace, reliable internet connectivity, and a secure working environment. Schedule Availability: Ability to work full-time, Monday through Friday, during the required hours for your time zone: Eastern Time: 9:30 a.m. – 6:15 p.m. Central Time: 8:30 a.m. – 5:15 p.m. Mountain Time: 7:30 a.m. – 4:15 p.m. Pacific Time: 6:30 a.m. – 3:15 p.m. Data Security and Compliance: Willingness to follow company security policies, use approved devices and software, apply secure access practices such as VPNs and strong passwords, and protect confidential health information. Preferred Qualifications Associate degree or additional relevant education. Healthcare experience combined with medical, claims, or collections call center experience. Medical terminology certification. Experience reading, interpreting, and explaining Explanation of Benefits (EOB) documents. Certified Benefits Professional Associate (BCPA) certification. Experience coordinating healthcare services, navigating insurance benefits, or supporting patient access and care coordination. Benefits Comprehensive Healthcare Coverage: Generously subsidized medical, dental, and vision insurance, including access to services through company healthcare products. Health and Spending Accounts: Health Savings Account (HSA), Flexible Spending Account (FSA), and Dependent Care Flexible Spending Account (DCFSA) options. Retirement Savings: 401(k) plan with company matching contributions and immediate vesting. Fully Remote Work: Work from home anywhere in the United States, with the necessary equipment provided. Flexible Work Environment: Remote working arrangements designed to support productivity and work-life balance. Paid Time Off: Generous PTO, including vacation, sick leave, and paid holidays. Parental Leave: Paid maternity and paternity leave to support growing families. Employee Assistance Program: Access to professional counseling, referrals, and additional personal and work-life support services. Pet Insurance: Optional coverage to help manage eligible veterinary expenses. Employee Discounts: Savings on phone plans, car rentals, computers, and other eligible purchases. Community Engagement: Opportunities to participate in philanthropic initiatives, including paid time off for community service. Professional Development: Opportunities to gain experience across healthcare programs, strengthen member service skills, and develop knowledge of healthcare operations. Purpose-Driven Culture: The opportunity to contribute to improving healthcare access, cost transparency, service quality, and the overall member experience.